Comparison of Incidental Radiation Dose to Axilla and Internal Mammary Nodal Area by Conventional, 3DCRT, and IMRT Technique in Carcinoma of Breast

Journal of Nuclear Medicine and Radiation Therapy Pub Date : 2017-02-10 DOI:10.4172/2155-9619.1000325

H. Govardhan, N. Thimmaiah, Khaleel Ia, S. Pradhan, R. Jain

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Abstract

Purpose: To quantify the incidental radiation dose delivered to axilla and internal mammary nodal (IMN) area by Conventional Tangential Radiation Therapy (CRT), 3 Dimensional Conformal Radiation Therapy (3DCRT) and Intensity Modulated Radiation Therapy (IMRT). Methods and Materials: We prospectively evaluated incidental radiation to axilla in twenty cases of breast cancer treated with adjuvant radiation therapy. Three plans were generated for each case, comprising CRT, 3DCRT and IMRT tangents. Radiation doses to axillary levels I, II, III, and IMN areas were evaluated for mean dose, V95, V80 and V50. Comparisons were made using ANOVA. Results: The mean volume and range of the axillary level I, II, III, and IMN were 61.1 cc and 142-57 cc; 42.6 cc and 61-21cc; 19.5 cc and 34-15 cc; 13.2 cc and 21-9 cc respectively. The mean dose to axilla by 3 techniques (by IMRT, 3DCRT and CRT) to Level I, II, III, and IMN were 75%, 53%, 38%, and 61% vs. 81%, 64%, 44% and 77% vs. 92%, 86%, 53% and 92% respectively (p<0.05). The V95 values (volume receiving 95% of dose) for the three techniques were 43%, 39%, 17% and 49% by IMRT: 40%, 45%, 21% and 59% by 3DCRT; 72%, 61%, 24% and 65% by CRT (IMRT vs. 3DCRT for level II axilla, IMRT vs. CRT and 3DCRT vs. CRT-p<0.05) The V80 were 49%, 53%, 29%, and 57% by IMRT; 55%, 47%, 34% and 68% by 3DCRT; 85%, 77%, 44% and 69% by CT (IMRT vs. 3DCRT for level III axilla and IMN, IMRT vs. CRT and 3DCRT vs. CRT -p<0.05). The V50 values were 75%, 65%, 41% and 66% by IMRT; 82%, 53%, 57% and 84% by 3DCRT; 94%, 89%, 42% and 90% by CRT (IMRT vs. 3DCRT, IMRT vs. CRT, and 3DCRT vs. CRP–p<0.05). Conclusion: Axillary and internal mammary nodal areas receive substantial amount of incidental radiation doses with all the three techniques; however, conformal techniques (IMRT, 3DCRT) deliver significantly lesser incidental radiation to lower axilla than CRT technique.

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常规、3DCRT及IMRT技术对乳腺癌腋窝及乳腺内结区偶发辐射剂量的比较

目的:量化常规切向放射治疗(CRT)、三维适形放射治疗(3DCRT)和调强放射治疗(IMRT)对腋窝和乳腺内结(IMN)区域的附带辐射剂量。方法与材料:对20例接受辅助放疗的乳腺癌患者腋窝附带放射进行前瞻性评价。每个病例生成三个平面图，包括CRT、3DCRT和IMRT切线。对腋窝水平I、II、III和IMN区域的辐射剂量进行了平均剂量、V95、V80和V50的评估。采用方差分析进行比较。结果:腋窝I、II、III和IMN的平均体积和范围分别为61.1 cc和142 ~ 57 cc;42.6 cc、61-21cc;19.5 cc和34-15 cc;分别为13.2 cc和21- 9cc。3种技术(IMRT、3DCRT、CRT)对ⅰ、ⅱ、ⅲ级、IMN的平均剂量分别为75%、53%、38%、61%和81%、64%、44%、77%和92%、86%、53%、92% (p<0.05)。三种方法的V95值(体积接受剂量的95%)IMRT分别为43%、39%、17%和49%，3DCRT分别为40%、45%、21%和59%;CRT分别为72%、61%、24%、65% (II级腋窝IMRT vs 3DCRT, IMRT vs CRT, 3DCRT vs CRT-p<0.05)。IMRT的V80分别为49%、53%、29%、57%;3DCRT分别为55%、47%、34%、68%;CT分别为85%、77%、44%和69% (IMRT vs 3DCRT对III级腋窝和IMN, IMRT vs CRT, 3DCRT vs CRT -p<0.05)。IMRT的V50值分别为75%、65%、41%和66%;82%、53%、57%、84%为3DCRT;94%， 89%， 42%， 90% (IMRT vs. 3DCRT, IMRT vs. CRT, 3DCRT vs. CRP-p <0.05)。结论:三种技术对腋窝和乳腺内结区均有较大的偶发辐射剂量;然而，适形技术(IMRT, 3DCRT)对腋下的附带辐射明显小于CRT技术。

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Journal of Nuclear Medicine and Radiation Therapy

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